Background: In older patients with acute myeloid leukemia (AML), the definition of fitness, prognosis, and risk of death represents an open question. Methods: In the present study, we tested the impact on survival of disease- and patient-related parameters in a large cohort of elderly AML patients homogeneously assigned to treatment with hypomethylating agents (HMAs). Results: In 131 patients with a median age of 76 years, we confirmed that early response (<0.001) and biology-based risk classification (p = 0.003) can select patients with better-predicted survival. However, a full disease-oriented model had limitations in stratifying our patients, prompting us to investigate the impact of baseline comorbidities on overall survival basing on a comorbidity score. The albumin level (p = 0.001) and the presence of lung disease (p = 0.013) had a single-variable impact on prognosis. The baseline comorbidity burden was a powerful predictor of patients' frailty, correlating with increased incidence of adverse events, especially infections, and predicted overall survival (p < 0.001). Conclusion: The comorbidity burden may contribute to impact prognosis in addition to disease biology. While the therapeutic armamentarium of elderly AML is improving, a comprehensive approach that combines AML biology with tailored interventions to patients' frailty is likely to fully exploit the anti-leukemia potential of novel drugs.

The baseline comorbidity burden affects survival in elderly patients with acute myeloid leukemia receiving hypomethylating agents: Results from a multicentric clinical study / Marconi G.; Candoni A.; Di Nicola R.; Sartor C.; Parisi S.; Abbenante M.; Nanni J.; Cristiano G.; Zannoni L.; Lazzarotto D.; Giannini B.; Baldazzi C.; Bandini L.; Ottaviani E.; Testoni N.; Bezzi C.D.G.; Abd-alatif R.; Ciotti G.; Fanin R.; Martinelli G.; Paolini S.; Ricci P.; Cavo M.; Papayannidis C.; Curti A.. - In: CANCER MEDICINE. - ISSN 2045-7634. - ELETTRONICO. - 12:10(2023), pp. 11838-11848. [10.1002/cam4.5858]

The baseline comorbidity burden affects survival in elderly patients with acute myeloid leukemia receiving hypomethylating agents: Results from a multicentric clinical study

Marconi G.;Di Nicola R.;Sartor C.;Parisi S.;Abbenante M.;Nanni J.;Cristiano G.;Zannoni L.;Baldazzi C.;Bandini L.;Ottaviani E.;Testoni N.;Paolini S.;Cavo M.;Papayannidis C.;Curti A.
2023

Abstract

Background: In older patients with acute myeloid leukemia (AML), the definition of fitness, prognosis, and risk of death represents an open question. Methods: In the present study, we tested the impact on survival of disease- and patient-related parameters in a large cohort of elderly AML patients homogeneously assigned to treatment with hypomethylating agents (HMAs). Results: In 131 patients with a median age of 76 years, we confirmed that early response (<0.001) and biology-based risk classification (p = 0.003) can select patients with better-predicted survival. However, a full disease-oriented model had limitations in stratifying our patients, prompting us to investigate the impact of baseline comorbidities on overall survival basing on a comorbidity score. The albumin level (p = 0.001) and the presence of lung disease (p = 0.013) had a single-variable impact on prognosis. The baseline comorbidity burden was a powerful predictor of patients' frailty, correlating with increased incidence of adverse events, especially infections, and predicted overall survival (p < 0.001). Conclusion: The comorbidity burden may contribute to impact prognosis in addition to disease biology. While the therapeutic armamentarium of elderly AML is improving, a comprehensive approach that combines AML biology with tailored interventions to patients' frailty is likely to fully exploit the anti-leukemia potential of novel drugs.
2023
The baseline comorbidity burden affects survival in elderly patients with acute myeloid leukemia receiving hypomethylating agents: Results from a multicentric clinical study / Marconi G.; Candoni A.; Di Nicola R.; Sartor C.; Parisi S.; Abbenante M.; Nanni J.; Cristiano G.; Zannoni L.; Lazzarotto D.; Giannini B.; Baldazzi C.; Bandini L.; Ottaviani E.; Testoni N.; Bezzi C.D.G.; Abd-alatif R.; Ciotti G.; Fanin R.; Martinelli G.; Paolini S.; Ricci P.; Cavo M.; Papayannidis C.; Curti A.. - In: CANCER MEDICINE. - ISSN 2045-7634. - ELETTRONICO. - 12:10(2023), pp. 11838-11848. [10.1002/cam4.5858]
Marconi G.; Candoni A.; Di Nicola R.; Sartor C.; Parisi S.; Abbenante M.; Nanni J.; Cristiano G.; Zannoni L.; Lazzarotto D.; Giannini B.; Baldazzi C.; Bandini L.; Ottaviani E.; Testoni N.; Bezzi C.D.G.; Abd-alatif R.; Ciotti G.; Fanin R.; Martinelli G.; Paolini S.; Ricci P.; Cavo M.; Papayannidis C.; Curti A.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/954677
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